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Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW: 260 (yes, with the band!)
Current Fill: 5cc in 10cc band
BMI: 49
Here's what I did: I gave up and I went in and acting like I wanted to start over. I went every month or two to get weighed and to complain that I was vomiting and throwing up. I did this for 9 additional months. Now I have just re-submitting for a revision authorization.
What the insurance companies don't understand is that many of us CANNOT be compliant without vomiting... grrrrr.
The lawyers are expensive and they won't take your case unless they can win...so be careful. Once you are labeled "non- compliant" I think it's hard to get out from under that.
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW: 260 (yes, with the band!)
Current Fill: 5cc in 10cc band
BMI: 49
I was denied for a revision May 2011 and then fought to the DMH****il 11/11. I just applied again with additional information. So I can't tell you how it will turn out.
It did NOT work to have the local doc submit for authorization last time. I thought if I could get a revision approved, I could change the surgery type later. Didn't work... With my insurance, requirements for the DS (the surgery I want) are different, so you'd better check that out.
This time I had the out of town surgoen's office send in the authorization, but I did all of the work locally. Does that make sense? In your case, it might be easier for you to do the same thing. Just have your records transferred to the new surgeon when you are finished with everything!
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW: 260 (yes, with the band!)
Current Fill: 5cc in 10cc band
BMI: 49
Good luck! I'm still jumping through hoops, but when I get approved I won't have it done until early next year.
I have an insurance question. My insurance requires a 6 month supervised diet or a multi-disciplinary surgical preparatory regimen for 3 months with certain criteria’s met. I am doing the 3 month program in my state where they think I am having one of their surgeries they offer which I am not. I am having the ds surgery which they don’t do here or really anywhere near me. I guess what I’m asking is after making it through all the criteria should I continue through this entire program right through to the surgeon (which I have not yet met) and let them approve it, then go to my DS surgeon’s office and see if they can get that one approved afterwards? I have one more Nut appointment left then all my steps for the insurance has been met the only thing I’d have to left to do would be to meet the surgeon and let them know what surgery I wanted then they would submit the approval. There is no way I can do all this from so far away from the ds surgery. Has anyone else been through this or any suggestions? I have aetna insurance.
Sorry if this is confusing I found it hard to explain.
Thanks,
Trish
Revision Lapband to RNY 2-6-2013 HW: 286 Pre-Op Diet: 277 Surgery Day: 265 Goal: 155 CW: 155
Plastic surgery 8/28/2014: Brachioplasty, mastopexy, & abdominoplasty.
Plastic surgery 1/27/2015: Butt Lift
I am hoping for some help. In 2005 i got the lap-band which i self paid for. Back then the doctor i had really didnt have any type of program like most places have now. Well in February i started a great program in hopes to get a revision for Gastric Bypass. I passed the program with flying colors and everyone thinks i am a great candiate for the bypass. Well insurance has denied me because i was not complianet with the lap-band. What it comes down to is that on one note that my doctor took it stated that i admitted to not following the nutrition guidelines even though i came back month after month nothing else was reported that i had changed and started following the guidelines. Considered i was self-pay i dont see how its relievant to what i did back then but again its insurance and they dont want to spend the money. This was 7 years ago a lot of things have changed including me. I was wondering if anyone has gone through this or has any tips for me. A couple people have suggested getting a lawyer but i just dont know.
Hockeymom87 · 0 replies · 728 views
